Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

Area of Science:

• Otolaryngology
• Sleep Medicine
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is a common condition characterized by upper airway collapse during sleep.
• Drug-induced sleep endoscopy (DISE) is a valuable tool for visualizing airway obstruction in OSA patients.
• Understanding how body mass index (BMI) affects obstruction patterns is crucial for tailoring treatments.

Purpose of the Study:

• To investigate the relationship between different body mass index (BMI) categories and specific drug-induced sleep endoscopy (DISE) obstruction patterns in adults with obstructive sleep apnea (OSA).
• To identify distinct patient subgroups with clinically significant velopharyngeal and oropharyngeal obstruction patterns based on BMI.

Main Methods:

• A retrospective chart review was conducted on 111 adult OSA patients who underwent DISE with dexmedetomidine sedation between 2016 and 2018.
• Airway obstruction was classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system.
• Patients were categorized into BMI groups: <25, 25–29.9, and ≥30 kg/m² for comparative analysis.

Main Results:

• Patients with lower BMI (<25 kg/m²) showed a higher likelihood of severe tongue base and epiglottis obstruction.
• Conversely, patients with higher BMI (≥30 kg/m²) were more prone to complete concentric velum obstruction and more severe oropharyngeal obstruction.
• Oropharyngeal obstruction without tonsil involvement was associated with more severe concurrent velum obstruction compared to cases with tonsillar obstruction.

Conclusions:

• BMI categories are significantly associated with distinct airway obstruction patterns across all levels during DISE in OSA patients.
• Specific velum and oropharynx collapse patterns appear to be linked to different BMI subgroups.
• These findings have potential implications for developing alternative treatments to positive airway pressure (PAP) therapy.